Everything had been building up to a meeting held early last year in Zanzibar, a tropical location off Africa’s east coast. About a hundred researchers, clinicians, and other HIV experts from Africa and beyond gathered to lay out ambitious plans for developing an innovative vaccine that could combat the disease, which disproportionately affects sub-Saharan Africa. The group, known as the BRILLIANT Consortium, had secured a substantial $45 million grant from the U.S. Agency for International Development (USAID) in 2023.
“I mean, it’s unprecedented,” remarks Nono Mkhize, a senior medical scientist at the National Institute for Communicable Diseases (NICD) in Johannesburg. “Having a consortium made up of African scientists addressing an African issue here in Africa is something truly special.”
The first year of the five-year grant had passed mostly in a virtual format. Now, they were gathered in Zanzibar, ready to put their expertise into action. After numerous presentations and discussions, they had shaped a solid plan to counter the virus. The scientific advisory board had endorsed the upcoming vaccine trials. “I remember the excitement was through the roof,” Mkhize reflects. “We were at the beginning of something big.” But just as the meeting was drawing to a close, the atmosphere shifted. An executive order signed by President Trump on January 20, 2025, froze all foreign aid pending review. Soon, there would be cuts to USAID programs, leading to chaos and uncertainty for an agency that had provided humanitarian aid for over sixty years.
“I recall a colleague from USAID saying to me at the end of the meeting, ‘I’m not sure if I’ll see you again,'” recalls Penny Moore, a virologist at the University of the Witwatersrand in South Africa. “I hadn’t anticipated how severely it would affect the program.” Shortly thereafter, work was halted. “That was crushing because we were on the verge of enrolling our first trial participants,” Moore explains. “It takes a long time to set up a clinical trial, but it can be shut down almost instantly.”
Dale Kitchin, a senior scientist at NICD, echoes this sentiment, stating, “I don’t think any of us knew what the future held. There was a general sense of alarm.”
This situation could have marked the end of their efforts. “In many ways, it felt like we had our legs cut off right as we were about to sprint,” says Linda-Gail Bekker, who heads the Desmond Tutu Health Foundation at the University of Cape Town, one of USAID’s partners. Yet, the team refused to surrender. They understood the science was solid and the urgency was real, so they committed to pushing forward.
They found new funding sources to support a scaled-back version of the HIV vaccine trial, none of which came from the U.S. government. “I’m afraid we’re going to have to do this with or without support, because it’s too important to abandon,” Bekker states.
According to Moore, this situation arose at a crucial moment in the battle against HIV. She doubts that treatments alone will suffice, even with new options like lenacapavir. “We need to get ahead of the virus, and I genuinely believe that can only happen with a vaccine,” she asserts. Moore has spent over two decades studying HIV, gradually piecing together a comprehensive picture of the virus. Her research, along with that of others, has also provided insights into how the human immune system works, leading to advancements against other diseases such as COVID-19 and cancer.
Much of her work has received support from U.S. sources. In her Johannesburg lab, equipment including refrigerators purchased with USAID funds is marked with agency stickers. Some even read, “from the American people.” “It’s there to remind us who backed us,” Moore explains.
In addition to the equipment, Moore’s research relies on 117 South African women who’ve contributed blood to her lab for two decades. “These women live in the communities most impacted by HIV,” she notes. “They donate in hopes of seeing an end to an epidemic that feels very personal.”
Over the years, these samples have been preserved in large freezers, essentially storing Moore’s career. “This is blood, cells, and DNA,” she says while lifting a heavy stack of frozen tubes. “The insights we’ve gained from these samples are astonishing.” The research has answered critical questions about why HIV is so adept at evading the immune system.
“It’s like an M&M, completely covered by sugars,” Moore illustrates. “These sugars essentially render the virus invisible to the immune system.” While other viruses, such as the one causing COVID-19, use similar sugary shields, HIV excels at hiding from human defenses. The virus’s frequent mutations also contribute to its ability to evolve in different locations. “The virus in Kenya isn’t the same as in Botswana or Senegal,” she highlights.
Moore was particularly thrilled about collaborating with colleagues from across Africa under the USAID grant, as it would allow trials to assess vaccine candidates against various strains of the virus in distinct populations. The vaccine project stemmed from critical insights her lab discovered a few years after some blood donors became infected. A small fraction developed broadly neutralizing antibodies, which can stop multiple HIV strains. “One such antibody might neutralize up to 90% of global variants,” Moore explains.
Interestingly, these antibodies tend to appear too late to help those already infected. “The virus has usually spread too far by that point,” says Nigel Garrett, chief scientific officer at the Desmond Tutu Health Foundation. “We need to implement a vaccine strategy to catch the virus before it enters the bloodstream.”
However, coaxing the immune system to produce these unique antibodies is quite challenging. The purpose of the USAID grant was to facilitate flexible trials that could determine the best way to activate the immune response. “We know what our goals are,” Moore admits. “I’m not saying we’re right around the corner, but I genuinely believe we’re closer than ever; that’s what frustrates me.”
After the loss of the USAID grant, everyone was understandably shaken. “There were plenty of hugs, tears, and a bit of swearing on my end,” Moore recalls. Despite the devastating funding cut, no one wanted to abandon the project. “It’s a tough blow, yes, but we’re determined to keep fighting,” says Sheetal Kassim, Senior Research Officer at the Desmond Tutu Health Foundation. “We’re fighters.”
The South African researchers devised a revised plan, focusing on a more localized initiative while reducing the scope of the trials. Despite the challenges, they believed in their cause. “We have to maintain momentum until we manage to control the epidemic,” Garrett states.
For Mfiki, the situation served as a wake-up call. “This is South Africa’s opportunity to show we can tackle local issues with our own resources,” she says. “Of course, we still need international support, but we shouldn’t rely entirely on it.”
The process, however, came with its own stressors. “We were frantically seeking grants from anyone willing to listen,” Moore reveals.
Ultimately, funding was secured from the South African Medical Research Council and the Gates Foundation, amounting to a fraction of the original USAID grant, and none originating from the U.S. government. The State Department did not comment on the cancellation of the fund or future support for similar initiatives.
Now, almost a year after the disruptions, participant screenings for the streamlined trials have commenced. In Philippi Village, known for its high HIV rates, a factory has been repurposed as a multi-purpose facility.
“It’s essential to work with these communities — not just in them — given their significant HIV burden,” Kassim emphasizes. Mfiki enters a room where around twenty young women await. “I’ll explain the trial criteria and who can participate,” she tells them, stressing the importance of community involvement in the trials.
Nandipha Mongo, another attendee who recently participated in a different HIV trial, expresses her pride in contributing to pivotal research. “I’m over the moon, man!” she exclaims. For Mongo, developing a vaccine would mean “living free,” especially given the challenges of gender-based violence and the omnipresent threat of HIV in her community.
The first vaccinations in this new trial are set to begin next week.
